title: Level I verification is associated with a decreased mortality rate after major torso vascular injuries.
abstract: Major torso vascular injuries (MTVIs) are frequently fatal. Our purpose was to determine whether the American College of Surgeons' (ACS) trauma center level of verification was associated with reduced mortality rates in a rural population-based community trauma center. Patients with blunt and penetrating MTVIs were retrospectively reviewed. Mortality rates were compared between Level II and Level I verification time periods. The primary outcome measured was death from MTVIs. Two hundred seventy-four patients (blunt, 167 [61%]; penetrating, 107 [39%]) representing 1.5 per cent of all trauma admissions were studied. Mortality decreased from 41 of 80 (51%) (Level II) to 60 of 194 (31%) (Level I) (P = 0.002) for the entire group. Mortality reduction occurred primarily in the subgroup with blunt and penetrating thoracic injuries (Level II, 24 of 33 [73%] vs Level I, 25 of 82 [30%]; P < 0.001). A significant reduction was not observed in patients with major abdominal vascular injuries (Level II, 17 of 47 [36%] vs Level I, 35 of 112 [31%]; P = 0.581). Level I status was associated with an overall decreased mortality rate from MTVIs despite low patient numbers. The commitment of hospital resources that are required to achieve Level I ACS verification in a community hospital improves survival, particularly in patients with blunt and penetrating thoracic injuries.
authors.affiliation: Trauma Service, Department of Surgery, East Texas Medical Center, Tyler, Texas 75701, USA. snorwo01@msn.com
authors.forename: Scott
authors.initials: S
authors.lastname: Norwood
authors.forename: Alan D
authors.initials: AD
authors.lastname: Cook
authors.forename: John D
authors.initials: JD
authors.lastname: Berne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D012424:Rural Population; D012955:Societies, Medical; D016019:Survival Analysis; D013781:Texas; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D014193:Trauma Centers / Q000592:standards; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D055815:Young Adult